PMT16-01812 City of Menifee Permit No.: PMT16-01812
29714 HAUN RD.
�CCEL/1 MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 12/21/2016
PERMIT
Site Address: 28369 KING APACHE CIR,MENIFEE, CA Parcel Number: 388-022-003
92584 Construction Cost: $187,873.55
Existing Use: 1 &2 Family Residence Proposed Use:
Description of RESIDENTIAL ADDITION OF 1267 SO FT, GARAGE 276sf, COV PORCH 87sf
Work:
Owner Contractor
WILLIAM EDWARDS
28369 KING APACHE CIR
MENIFEE,CA 92584
Applicant License Number:
WILLIAM EDWARDS
28369 KING APACHE CIR
MENIFEE,CA 92584
Phone:9515361705
Fee Description Div Amount 151
Services, Switchboards, Control Centers&Panels 3 348.00
Receptacle, Switch, Outlet& Fixture 71 466.00
Plumbing Fixtures and Vents, fixtures 8 141.00
Piping/Repiping Single Family Residential 1 163.00
Water Heater 1 83.00
Sewer 1 150.00
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 90 90.00
Additional Plan Review Building 1,227 1,227.00
GREEN FEE 1 1.00
GREEN FEE 1 6.00
SMIP RESIDENTIAL 1 20.00
SMIP RESIDENTIAL 1 2.00
New Construction Permit Fee 1 689.94
General Plan Maintenance Fee-Mechanical 1 14.10
General Plan Maintenance Fee-Plumbing 1 32.65
General Plan Maintenance Fee-Electrical 1 40.70
General Plan Maintenance Fee-New 1 34.50
Construction
$3,817.89
AA_Bldg_Permft_Template.rpt Page 1 of 2
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts far the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason: -
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires Signature In which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is subm a or at the following website:
by Section 3700 of the Labor Code,forthe performance of work for which www I in ov cal w
mi
this permit is issued. z l
Policy# Date
PROPE ON O
❑I have and will maintain workers compensation Insurance,as required by W ERRAUIHORIZEDAGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.1 have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I aut ' e representatives of this city or county to
Policy# Expires enter th aye identified ro rty for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date Z� /
dollars($100)or less
PROPERtJ OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts spe W d on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes miro
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR[ODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)7 See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes otldo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit Is issued outer bounddryry of a school?
(Section 3097 Civil Code) ❑Yes RN".
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code, ecti n 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous erial reporting.
oYes
Business and Professions Code).Any city or county that requires a permit to Date Z
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY NER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she Is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
than 00).
as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. No EPA Lead-Safe Certified Firm is required forthis project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contactors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE C6,/ /6 PERMIT/PLAN CHECK NUMBER O
TYPE: " COMMERCIAL 0 RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME ^. POOL/SPA O SIGN
SUBTYPE: V ADDITION O ALTERATION O DEMOLITION O ELECTRICAL C MECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS2`Ac!/C
ASSESSOR'S PARCEL NUMBER S S,f o 22 QQ ? Co/ LOT 3 / TRACT a7 7?(,
OWNER NAME e/✓,c e-(A, C.�akf'i�s
ADDRESS 2 ,S ?6
PHONE S-?E / ?�S— EMAIL GG{(A-,
APPLICANT NAME S'qq
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? &YES ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ / SiD. a SQFT W2 LSQFT
APPLICANT'S SIGNATURE �Y DATE 0
-/21
0kUSE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
AMOUNT 1�. PAID AMOUNT
O CASH C CHECK# ::CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT
�% CASH `✓`CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building &Sofety Deportment 29714 Houn Rd. Menifee, CA 92586951-672-6777
www.cityo finenifee.us inspection Request Line 951-246-G213
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